TIGHT SPACES Enhanced imaging consoles let surgeons see more on-screen detail.

Now's a good time to be in the market for a new arthroscopy imaging system. Several exciting advancements are available, innovative technology seems to hit the market every few months and competition is heating up among manufacturers, so vendors are looking to deal. Our orthopedic center recently decided to upgrade our 5-year-old video platform and took advantage of the buyer's market to trial several new systems. Here are a few things we learned during the shopping process and what you should consider when deciding to improve your surgeons' views of the action.

In love with 4K
The biggest advancement in recent years? Hands down, the introduction of 4K ultra high-definition video. When we set out to purchase a new system, we knew we wanted to take a look at 4K. It was love at first sight for my surgeons. 4K has 4 times the resolution and more intense color than standard 1080p HD systems, making visualization of the joint much easier. That enhanced resolution is especially important during arthroscopy, when surgeons work off a tight circular field of view on the monitor. 4K really makes images "pop" on the screen, so surgeons can easily see in the nooks and crannies of the joint and more easily deal with the fluid, air bubbles and blood that can impede good views.

However, it's important to note that few manufacturers offer true 4K systems in which both the camera and monitor capture and depict 4K images. While these true 4K systems may work well in abdominal surgery applications, we learned during our trial that a 4K camera has to be about 10 mm in order to capture enough light to take full advantage of 4K technology. That scope size is simply too large for use in a joint.

EVEN FLOW Automated irrigation pumps help maintain distention pressure in the joint for good visualization and a stable operative field.

Because of that limitation, the system we chose has a 1080p camera and a 4K monitor. Our surgeons say that setup still gives them an improved depth of field, which provides clearer visualization when moving from the front to the back of the joint. That means surgeons refocus the camera less often and can potentially operate faster.

Our system also features image enhancement technology, which improves surgeons' visualization. For example, surgeons can press a "stretch" button to enhance the red colors of the displayed image. During a knee meniscectomy, the stretch feature improves visualization of blood flow in soft tissues to let surgeons make more informed cuts by removing only tissue that is lacking vascularization. There are also other image enhancement technologies available that use digital processing to brighten dark areas and cut through fog and debris, though we didn't trial those systems.

The whole package
When choosing a video system, don't overlook these important features:

TEST DRIVE Trial systems for extended periods to give surgeons and staff the time they need to make informed decisions.

• Video integration. One of the biggest benefits of our new system is its robust surgical video integration platform, which lets surgeons show the patient's family videos and pictures on a handheld tablet of the procedure he just performed . Surgeons can also easily annotate the images and videos to clarify them in patient records. Another big benefit: Our system integrates with our EMR. Instead of printing out images of procedures, surgeons can now send them directly to patients' charts. That's a timesaving feature and also limits what can be significant spending on printer ink cartridges and paper.
• Auxiliary equipment. Buying an imaging system is a big investment. You're not just buying a new arthroscopic console. You're likely replacing your video tower, scopes, shavers, burrs, irrigation pumps and disposables. As a former materials manager, I made sure that when we upgraded our video system, we also upgraded all of those auxiliary items. Bundling these items can get you a better overall deal and, when you update everything at the same time and use the same manufacturer, maintenance contracts are simpler to negotiate. It's also less likely that you'll run into equipment compatibility issues down the road.
• Automated irrigation. The platform we chose works with an automated irrigation pump that requires a lot less saline to open up the joint for good visualization. Older pumps that irrigate the joint at a constant pressure can go through 3,000 cc bags of irrigation solution in just a few minutes. Pumps that don't adequately irrigate the joint can cause air bubbles to form or allow blood into the surgical site, which impairs the surgeon's view. An automated pump can sense pressure changes that occur throughout the case — when a burr is activated, for example — and adjust the flow of fluid accordingly. With the ongoing shortage of saline solution, finding a system that ensures the joint stays open while also minimizing the amount of fluid pumped into the area can help your bottom line.
• User-friendliness. It might sound obvious, but don't overlook how easy the video system is for staff and surgeons to use. If the platform is hard to connect or set up, no one will like using it — no matter how eye-popping the images are.

Conduct extended trials to accurately assess the user-friendliness and clinical performance of each one. While some facility leaders suggest trialing platforms for a set amount of time — 1 or 2 weeks, perhaps — I let my surgeons use a system for as long as it takes for them to get a true sense of how it works in practice. Let surgeons use a system for several cases in order to familiarize themselves with the features they like and how it stacks up against the other platforms you're trialing. That truly lets them get a feel for whether the system will improve their views of surgery and how it will benefit the facility as a whole.

Don't forget to ask your nurses and surgical techs for feedback about how easy a system is to clean, how it connects to your printer or EMR system, and how quickly it can be set up before a case. In general, it's usually pretty easy to spot the winning system in the group — surgeons and staff will often agree that it's the best overall fit.

Art of the deal
Enter sales negotiations with a price in mind, and the exact features and equipment you want included on the system you're purchasing. The market is so competitive right now that you can secure excellent financing just by standing firm. Don't forget about the cost of disposables. You don't want to buy a new system at a reduced price only to have the cost of single-use supplies negate the savings you worked so hard to get. Remember that your focus shouldn't be on finding the most inexpensive system — it should be on getting a great product for less. OSM